Hodgkin lymphoma in the Swiss HIV Cohort Study
ABSTRACT Hodgkin lymphoma (HL) risk is elevated among persons infected with HIV (PHIV) and has been suggested to have increased in the era of combined antiretroviral therapy (cART). Among 14,606 PHIV followed more than 20 years in the Swiss HIV Cohort Study (SHCS), determinants of HL were investigated using 2 different approaches, namely, a cohort and nested case-control study, estimating hazard ratios (HRs) and matched odds ratios, respectively. Forty-seven incident HL cases occurred during 84,611 person-years of SHCS follow-up. HL risk was significantly higher among men having sex with men (HR vs intravenous drug users = 2.44, 95% confidence interval [CI], 1.13-5.24) but did not vary by calendar period (HR for 2002-2007 vs 1995 or earlier = 0.65, 95% CI, 0.29-1.44) or cART use (HR vs nonusers = 1.02, 95% CI, 0.53-1.94). HL risk tended to increase with declining CD4(+) cell counts, but these differences were not significant. A lower CD4(+)/CD8(+) ratio at SHCS enrollment or 1 to 2 years before HL diagnosis, however, was significantly associated with increased HL risk. In conclusion, HL risk does not appear to be increasing in recent years or among PHIV using cART in Switzerland, and there was no evidence that HL risk should be increased in the setting of improved immunity.
SourceAvailable from: Simon CollinsHIV Medicine 03/2014; 15 Suppl 2:1-92. DOI:10.1111/hiv.12136 · 3.45 Impact Factor
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ABSTRACT: The impact of highly active antiretroviral therapies (HAART) on the risk of non-AIDS-defining cancers (NADCs) and the role of biological and clinical factors in their pathogenesis are debated issues. The purpose of this review is to examine the epidemiology, etiology, and not-yet-defined pathogenic characteristics of NADCs and discuss topics such as treatment strategies, comorbidity, and multidrug interactions. Four types of NADCs that deserve special attention are examined: anal cancer, Hodgkin lymphoma (HL), hepatocellular carcinoma, and lung cancer.METHODS: The PubMed database and the Cochrane Library were searched by focusing on NADCs and on the association among NADCs, HAART, aging, and/or chronic inflammation. All articles were reviewed to identify those reporting variables of interest.RESULTS: NADC incidence is twofold higher in patients with HIV/AIDS than in the corresponding general population, and this elevated risk persists despite the use of HAART. The mechanisms that HIV may use to promote the development of NADCs are presently unclear; immunological mechanisms, either immunodeficiency and/or immunoactivation, may play a role.CONCLUSION: Recent clinical studies have suggested that equivalent antineoplastic treatment is feasible and outcome can be similar in HIV-infected patients on HAART compared with uninfected patients for the treatment of HL and anal and lung cancers. However, patients with advanced HIV disease and/or aging-related comorbidities are likely to experience worse outcomes and have poorer tolerance of therapy compared with those with less advanced HIV disease.The Oncologist 06/2014; 19(8). DOI:10.1634/theoncologist.2014-0024 · 4.54 Impact Factor
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ABSTRACT: Hodgkin lymphoma (HL) is more frequent in patients with Human Immunodeficiency Virus (HIV) infection than in immunocompetent patients. The relationship between the immune system and HL is complex. Whilst the incidence of HL in HIV patients has most likely increased since the introduction of combined anti-retroviral therapy (cART), there is no doubt that the outcomes for patients with HIV and HL (HIV-HL) have improved since its introduction. Improved CD4 counts and risk-adapted treatment schedules have resulted in outcomes for patients with HIV-HL that are comparable to those in HIV-negative patients with HL. Thus, HIV-HL should be treated in the same way as HL in immunocompetent patients, including the use of salvage chemotherapy and autologous transplant in the relapsed setting in HIV-HL. Along the same lines, patients with HIV-HL should not be excluded from trials based on their immune status alone.Current Hematologic Malignancy Reports 06/2014; 9(3). DOI:10.1007/s11899-014-0215-4